Hemorrhoids are cushions of swollen blood vessels located in the lower rectum and anus that become bothersome when they swell or prolapse. When conservative home treatments fail to resolve symptoms like bleeding or discomfort, rubber band ligation (banding) is a common, effective, and minimally invasive procedure recommended by doctors. Patients often wonder if this treatment offers a permanent solution, or if the condition can return.
How Hemorrhoid Banding Works
Rubber band ligation is an office-based procedure primarily used to treat internal hemorrhoids, which originate just above the dentate line in the anal canal. The technique involves placing a small, tight elastic band around the base of the hemorrhoid tissue, completely cutting off the blood supply to the swollen vessel.
This lack of blood flow causes the tissue to wither and die, a process that typically takes about a week. The banded hemorrhoid then sloughs off, usually passing unnoticed during a bowel movement. A small scar forms where the tissue was attached, which helps anchor the remaining tissue and prevents prolapsing again.
The Likelihood of Hemorrhoid Recurrence
The short answer is yes, hemorrhoids can come back after banding, although the treated tissue itself rarely returns. Recurrence usually means new hemorrhoids have developed in nearby tissue due to the same underlying causes, not that the original banded site has failed. This distinction is important because the procedure successfully treats the existing swollen tissue.
Long-term studies indicate that while banding is highly successful initially, a portion of patients will experience a return of symptoms over time. The recurrence rate ranges widely, with some data showing a relapse rate of around 13% to 17% within five years. After ten years, the success rate may drop to about 68%, highlighting the chronic nature of the condition. Symptoms of recurrence are the same as the initial problem, commonly including rectal bleeding, itching, or prolapse.
Lifestyle Factors That Cause Recurrence
The primary reason new hemorrhoids form after successful banding is the continued existence of the factors that caused the initial problem. Any activity that increases pressure within the abdomen and lower rectum can strain the remaining vascular cushions. Chronic straining during bowel movements is a major contributor, often caused by a diet low in fiber or inadequate fluid intake leading to hard stools.
Sitting on the toilet for extended periods also increases pressure on the anal veins, causing them to swell. Occupational factors, such as prolonged sitting or standing, can similarly impede blood flow and increase venous pressure. Other physical stresses, including frequent heavy lifting, obesity, and pregnancy, also contribute to the development of new hemorrhoidal tissue.
Treatment Options for Recurring Hemorrhoids
If symptoms return, the first line of defense is a renewed focus on lifestyle modifications that prevent straining and pressure. When these changes are not enough, treatment options depend on the severity and location of the new hemorrhoids. For many cases of recurrence, repeat rubber band ligation is an effective and common option, as the procedure can be performed multiple times on different tissue areas.
If the tissue is not suitable for repeat banding, doctors may use other non-surgical, office-based treatments. These include sclerotherapy, which involves injecting a chemical solution to shrink the hemorrhoid, or infrared coagulation, which uses heat to cause the tissue to shrivel. For severe or frequently recurring cases that resist non-surgical approaches, a surgical procedure like a hemorrhoidectomy may be necessary for a more definitive solution.